Global Prevalence of Fecal Incontinence in Community-Dwelling Adults: A Systematic Review and Meta-analysis
Authors: Isabelle Mack, Heiko Hahn, Celina Gödel, Paul Enck, Adil E. Bharucha
Journal: Clinical Gastroenterology and Hepatology (2023)

Background & AimsFecal incontinence (FI) can considerably impair quality of life. Through a systematic review and meta-analysis, we sought to determine the global prevalence and geographic distribution of FI and to characterize its relationship with sex and age.MethodsWe searched PubMed, Web of Science, and Cochrane Library databases to identify population-based surveys of the prevalence of FI.ResultsOf the 5175 articles identified, the final analysis included 80 studies; the median response rate was 66% (interquartile range [IQR], 54%–74%). Among 548,316 individuals, the pooled global prevalence of FI was 8.0% (95% confidence interval [CI], 6.8%–9.2%); by Rome criteria, it was 5.4% (95% CI, 3.1%–7.7%). FI prevalence was greater for persons aged 60 years and older (9.3%; 95% CI, 6.6%–12.0%) compared with younger persons (4.9%; 95% CI, 2.9%–6.9%) (odds ratio [OR], 1.75; 95% CI, 1.39–2.20), and it was more prevalent among women (9.1%; 95% CI, 7.6%–10.6%) than men (7.4%; 95% CI, 6.0%–8.8%]) (OR, 1.17; 95% CI, 1.06–1.28). The prevalence was highest in Australia and Oceania, followed by North America, Asia, and Europe, but prevalence could not be estimated in Africa and the Middle East. The risk of bias was low, moderate, and high for 19 (24%), 46 (57%), and 15 (19%) studies, respectively. Exclusion of studies with high risk of bias did not affect the prevalence of FI or heterogeneity. In the meta-regression, the high study heterogeneity (I2 = 99.61%) was partly explained by age.ConclusionsApproximately 1 in 12 adults worldwide have FI. The prevalence is greater among women and older people. Fecal incontinence (FI) can considerably impair quality of life. Through a systematic review and meta-analysis, we sought to determine the global prevalence and geographic distribution of FI and to characterize its relationship with sex and age. We searched PubMed, Web of Science, and Cochrane Library databases to identify population-based surveys of the prevalence of FI. Of the 5175 articles identified, the final analysis included 80 studies; the median response rate was 66% (interquartile range [IQR], 54%–74%). Among 548,316 individuals, the pooled global prevalence of FI was 8.0% (95% confidence interval [CI], 6.8%–9.2%); by Rome criteria, it was 5.4% (95% CI, 3.1%–7.7%). FI prevalence was greater for persons aged 60 years and older (9.3%; 95% CI, 6.6%–12.0%) compared with younger persons (4.9%; 95% CI, 2.9%–6.9%) (odds ratio [OR], 1.75; 95% CI, 1.39–2.20), and it was more prevalent among women (9.1%; 95% CI, 7.6%–10.6%) than men (7.4%; 95% CI, 6.0%–8.8%]) (OR, 1.17; 95% CI, 1.06–1.28). The prevalence was highest in Australia and Oceania, followed by North America, Asia, and Europe, but prevalence could not be estimated in Africa and the Middle East. The risk of bias was low, moderate, and high for 19 (24%), 46 (57%), and 15 (19%) studies, respectively. Exclusion of studies with high risk of bias did not affect the prevalence of FI or heterogeneity. In the meta-regression, the high study heterogeneity (I2 = 99.61%) was partly explained by age. Approximately 1 in 12 adults worldwide have FI. The prevalence is greater among women and older people.